Creating a Culture of Health

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1 Creating a Culture of HealthA Call to Action:Creating a Culture of Health2010 AHA Long Range Policy Committee ReportJanuary 2011

2 A Call to Action: Creating a Culture of HealthA bold call to action for hospitals and their employees to be leaders in creating a culture of healthBackground on hospital health and wellness programsFindings from a groundbreaking AHA survey on hospital employee health and wellness activitiesExamples of hospital best practices“How-to" recommendations for the fieldHospitals in Pursuit of Excellence (HPOE) is informed by and also informs the AHA’s advocacy work and our long-term system reform (Health for Life).HPOE is one of our 3 legs for AHA as it relates to our overall mission.

3 Why Health and Wellness?Hospital and health system employees play critical role in their communities to lead the way and serve as role models for healthy living and fitnessFinancial case for creating a culture of health through potential cost savings and improved employee recruitment and retentionHospitals and health systems contributing to achievement of national public health goals in Healthy People 2020ACA incentives to promote employee health and wellnessHPOE is the AHA strategy for accelerating performance improvement.HPOE started by initially focusing on 4 topics: (preventing infections, harm, medication safety and patient flow).In the last few months HPOE added 2 more topics: care coordination and implementing HIT.The next topic for HPOE is improving efficiency.

4 Survey on Hospital Employee Health and Wellness ActivitiesNational survey of hospital employee health and wellness activities conducted May-June 2010876 responsesnationally representative of all hospitals in terms of hospital size, teaching status, and census regionurban hospitals and hospitals that were members of a health system slightly overrepresentedHPOE is the AHA strategy for accelerating performance improvement.HPOE started by initially focusing on 4 topics: (preventing infections, harm, medication safety and patient flow).In the last few months HPOE added 2 more topics: care coordination and implementing HIT.The next topic for HPOE is improving efficiency.

5 Survey on Hospital Employee Health and Wellness ActivitiesMost hospitals (86%) have an employee health and wellness program, the vast majority of which (80%) are directly administered by the hospital or health system.The top motivators for offering a program are to reduce healthcare costs, improve the health of employees and reduce absenteeism/presenteeism, improve employee morale and productivity, and provide an example to the community.The most common wellness programs offered include flu shots, EAP/mental health services, smoking cessation programs, and healthy food options.HPOE is the AHA strategy for accelerating performance improvement.HPOE started by initially focusing on 4 topics: (preventing infections, harm, medication safety and patient flow).In the last few months HPOE added 2 more topics: care coordination and implementing HIT.The next topic for HPOE is improving efficiency.

6 Survey on Hospital Employee Health and Wellness ActivitiesThere is a wide variation in the percentage of hospital employees participating in health and wellness programs, with 42% of hospitals reporting that at least half of their employees participate in one or more programs.Hospitals promote their wellness programs through health fairs (76%), health risk assessments (70%), and incentives (66%). The overwhelming majority of hospitals that offer incentives use positive incentives such as health insurance premium discounts or gift cards.HPOE is the AHA strategy for accelerating performance improvement.HPOE started by initially focusing on 4 topics: (preventing infections, harm, medication safety and patient flow).In the last few months HPOE added 2 more topics: care coordination and implementing HIT.The next topic for HPOE is improving efficiency.

7 Survey on Hospital Employee Health and Wellness ActivitiesMost hospitals (76%) require that employees participate in at least one wellness program. Many hospitals also offer incentives for employees who complete a wellness program (50%) and achieve outcomes based on participation (39%).HRA completion, participation in weight management or smoking cessation program, and completion of a biometric screening are activities commonly linked to incentives. Hospitals with more than 200 beds are more likely to utilize incentives.HPOE is the AHA strategy for accelerating performance improvement.HPOE started by initially focusing on 4 topics: (preventing infections, harm, medication safety and patient flow).In the last few months HPOE added 2 more topics: care coordination and implementing HIT.The next topic for HPOE is improving efficiency.

8 Survey on Hospital Employee Health and Wellness ActivitiesSlightly less than half (47%) of hospitals that use incentives discount between 5% and 20% of an employee’s monthly premium for participating in health and wellness programs.A third of hospitals that use incentives award employees who meet health and wellness incentives between $100 and $300 annually. An additional 41% of hospitals award $100 or less.HPOE is the AHA strategy for accelerating performance improvement.HPOE started by initially focusing on 4 topics: (preventing infections, harm, medication safety and patient flow).In the last few months HPOE added 2 more topics: care coordination and implementing HIT.The next topic for HPOE is improving efficiency.

9 Survey on Hospital Employee Health and Wellness ActivitiesOne-third of hospitals have made an attempt to measure the return on investment (ROI) of employee health and wellness programs, and only 7% have successfully measured ROI. Of those who have successfully measured ROI, the current median ROI of health and wellness initiatives is between 2:1 and 3:1.Eighty-two percent (82%) of respondents who measure ROI report that their ratio is equal to or exceeds expectations.The most common measures used in evaluating ROI are number of participants, number of completed HRAs, overall direct health care costs, number exercising regularly, and number achieving weight loss.HPOE is the AHA strategy for accelerating performance improvement.HPOE started by initially focusing on 4 topics: (preventing infections, harm, medication safety and patient flow).In the last few months HPOE added 2 more topics: care coordination and implementing HIT.The next topic for HPOE is improving efficiency.

10 Survey on Hospital Employee Health and Wellness ActivitiesMotivating employees over extended time periods, financial restrictions or limitations, measuring program effectiveness, and creating a culture of health are noted as the most serious challenges to program effectiveness. Urban hospitals and hospitals with more than 200 beds find it more challenging to communicate to their employees about health and wellness activities.Getting better ROI data is the most important opportunity for improving health and wellness programs. Additional opportunities include providing more incentives to employees, providing new programs, and providing different types of incentives.HPOE is the AHA strategy for accelerating performance improvement.HPOE started by initially focusing on 4 topics: (preventing infections, harm, medication safety and patient flow).In the last few months HPOE added 2 more topics: care coordination and implementing HIT.The next topic for HPOE is improving efficiency.

11 Our Recommendations Serve as a role model of health for the community.Create a culture of healthy living.Provide a variety of program offerings.Provide positive and negative incentives.Track participation and outcomes.Measure for ROI.Focus on sustainability.HPOE is the AHA strategy for accelerating performance improvement.HPOE started by initially focusing on 4 topics: (preventing infections, harm, medication safety and patient flow).In the last few months HPOE added 2 more topics: care coordination and implementing HIT.The next topic for HPOE is improving efficiency.

12 Serve as a role model of health for the community.RecommendationsServe as a role model of health for the community.Use wellness programs as pilots to export to the whole community as part of a population-based approach to health careOffer health and wellness program benefits to all dependents of employeesWork with local employers to build an integrated, regional approach to health and wellnessProvide free wellness programs at local community centers.HPOE supports the field by 3 main ways:EducationProductsNational Implementation EffortsWe will discuss each of these in detail, but quickly:Education is evident through our website-www.hpoe.org with case studies, webinars and communication through various AHA news sourcesProducts are our toolkits and guides, such as the readmissions action guide that we will discuss later.National Implementation Efforts are our 2 major, nationally funded projects to prevent central line associated blood stream infections and catheter associated urinary tract infections.

13 2. Create a culture of healthy living.Recommendations2. Create a culture of healthy living.Promote a holistic approach to wellnessStart commitment to culture change at the top—with the CEO and the board of trusteesConsider creating a wellness department led by a chief wellness officer who reports directly to the CEOMake changes to the work environment that promote healthy behaviorHPOE supports the field by 3 main ways:EducationProductsNational Implementation EffortsWe will discuss each of these in detail, but quickly:Education is evident through our website-www.hpoe.org with case studies, webinars and communication through various AHA news sourcesProducts are our toolkits and guides, such as the readmissions action guide that we will discuss later.National Implementation Efforts are our 2 major, nationally funded projects to prevent central line associated blood stream infections and catheter associated urinary tract infections.

14 3. Provide a variety of program offerings.Recommendations3. Provide a variety of program offerings.Include a health risk assessment (HRA) and biometric screening in all hospital wellness programsImplement at least one intensive coaching activityMake smoking cessation mandatory for all employees and subsidize and/or offer only healthy food options in all hospital cafeterias and vending machinesRe-evaluate wellness programs annually and adjust as necessaryHPOE supports the field by 3 main ways:EducationProductsNational Implementation EffortsWe will discuss each of these in detail, but quickly:Education is evident through our website-www.hpoe.org with case studies, webinars and communication through various AHA news sourcesProducts are our toolkits and guides, such as the readmissions action guide that we will discuss later.National Implementation Efforts are our 2 major, nationally funded projects to prevent central line associated blood stream infections and catheter associated urinary tract infections.

15 4. Provide positive and negative incentives.Recommendations4. Provide positive and negative incentives.Expand use of incentives to improve participation levelsExperiment with various types of incentives and measure effect on participation and outcomesShift toward more outcomes-based incentives as participation increasesHPOE supports the field by 3 main ways:EducationProductsNational Implementation EffortsWe will discuss each of these in detail, but quickly:Education is evident through our website-www.hpoe.org with case studies, webinars and communication through various AHA news sourcesProducts are our toolkits and guides, such as the readmissions action guide that we will discuss later.National Implementation Efforts are our 2 major, nationally funded projects to prevent central line associated blood stream infections and catheter associated urinary tract infections.

16 5. Track participation and outcomes.Recommendations5. Track participation and outcomes.Initially focus on measuring and increasing participation levels, then move on to tracking outcomesTrack participation levels in a number of ways, e.g., number of overall participants, number completing a HRA, number enrolled in smoking cessation programsTrack outcomes in a number of ways, e.g., number who achieved weight loss, number who ceased smokingHPOE supports the field by 3 main ways:EducationProductsNational Implementation EffortsWe will discuss each of these in detail, but quickly:Education is evident through our website-www.hpoe.org with case studies, webinars and communication through various AHA news sourcesProducts are our toolkits and guides, such as the readmissions action guide that we will discuss later.National Implementation Efforts are our 2 major, nationally funded projects to prevent central line associated blood stream infections and catheter associated urinary tract infections.

17 Recommendations 6. Measure for ROI.Ensure multi-year commitment to measurement, evaluation and improvementStart small by measuring ROI on subset of wellness programsFocus attention on finding effective metrics—”hard” and “soft”—that work for your institutionFor validity, match employees who have undergone an intervention with employees with similar characteristics who did not participateHPOE supports the field by 3 main ways:EducationProductsNational Implementation EffortsWe will discuss each of these in detail, but quickly:Education is evident through our website-www.hpoe.org with case studies, webinars and communication through various AHA news sourcesProducts are our toolkits and guides, such as the readmissions action guide that we will discuss later.National Implementation Efforts are our 2 major, nationally funded projects to prevent central line associated blood stream infections and catheter associated urinary tract infections.

18 7. Focus on sustainability.Recommendations7. Focus on sustainability.Approach wellness as a constant activity, not just an annual eventDedicate resources to constantly communicate—through multiple modes and media—with staff, educate and incentivize participationIf necessary, start small, demonstrate success, and build up to full range of wellness activitiesChange programs and incentives as necessary to maintain high levels of participationHPOE supports the field by 3 main ways:EducationProductsNational Implementation EffortsWe will discuss each of these in detail, but quickly:Education is evident through our website-www.hpoe.org with case studies, webinars and communication through various AHA news sourcesProducts are our toolkits and guides, such as the readmissions action guide that we will discuss later.National Implementation Efforts are our 2 major, nationally funded projects to prevent central line associated blood stream infections and catheter associated urinary tract infections.

19 Health and Wellness Best PracticesHospital/Health SystemBest PracticeTruman Medical Centers, Kansas City, MO“PTO for Wellness” program – allows employees to trade paid time off (PTO) hours for reimbursements for wellness-related expensesOchsner Health System, Jefferson, LAVoluntary wellness program with significant insurance premium discountSentara Healthcare, Norfolk, VAMission: Health, an incentive-based wellness and disease management programSt. Elizabeth Medical Center, Wabasha, MNRobust wellness program with numerous offerings that is managed by a wellness committeeHCA, Inc., Nashville, TNCalculates ROI of a diabetes pilot program in multiple ways, with a focus on clinical outcomes and claims-reduction dataHenry Ford Health System, Detroit, MIDeveloping data collection methodology at beginning of interventional, controlled trial for chronic back pain with major employer provided data to expand program to other employers and community organizations

20 A Call to Action: Creating a Culture of HealthHospitals in Pursuit of Excellence (HPOE) is informed by and also informs the AHA’s advocacy work and our long-term system reform (Health for Life).HPOE is one of our 3 legs for AHA as it relates to our overall mission.